Monday, September 13, 2010

Family physicians are seeing overweight and obese patients now more than ever. Therefore, the June 15, 2010 AFP article "Office-Based Strategies for the Management of Obesity" was timely, relevant, and informative. The author’s recommendations regarding counseling to improve nutrition and increase physical activity were insightful. I would like to draw attention to additional issues that have a significant impact on the fight against obesity in our patients, particularly those in minority or low income populations.

Excess weight begins with an energy imbalance: more calories consumed than calories expended over a period of time. Choosing foods such as fresh fruits and vegetables and physical activities such as jogging or vigorous outdoor play are vital to living a healthy lifestyle. But for many of our patients, these choices are not so simple. African Americans, Hispanics, and American Indians are disproportionately affected by obesity. Geographically, southern states and many rural and urban communities have higher than average rates of obesity. These communities have additional barriers that make it particularly challenging to achieve and maintain a healthy weight.

Millions of minority children live in food deserts, places where healthy, fresh food is either scarce, expensive or both. This lack of access to affordable, quality fresh fruits and vegetables has been shown to be closely associated with childhood obesity. According to Trust for America's Health and the Robert Wood Johnson Foundation, an overabundance of fast food outlets and convenience stores stocked with calorie-dense, nutrient-poor foods in areas with predominantly minority populations is strongly related to excess weight in these populations. Media and food industries advertise these foods widely, often targeting children and families of color. Similarly, many minority and low-income neighborhoods discourage physical activity due to a dearth of sidewalks, walking or bike trails, poor air quality, inadequate lighting and unkempt or inaccessible parks and playgrounds. Other factors such as long work hours for low-wage workers and limited access to commercial weight management services also pose substantial barriers to positive health behavior changes.

While it is important for family physicians to know how to assist our patients with weight control in the office, we should understand that the root causes of this problem lie in our communities. In order to "bend the curve" on the linear trajectory of obesity in this country, we must focus as intently on effecting broader social and environmental changes as we do on encouraging individual lifestyle changes in overweight and obese patients. As we educate our patients on how to live healthier, we must also educate, motivate and mobilize patients, community leaders, school administrators, employers, and policymakers about what it will take to make healthier food choices and physical activity default options rather than difficult or unrealistic choices. Family physicians must use every resource at our disposal to combat obesity, or else in time, we will all be "the biggest losers.”

2 comments:

The dirty little secret is that we are fighting evolution, that makes us put on weight when there is enough food, so we live through the famine.

And the other dirty little secret is that few obese folks ever get thin and remain thin. So I spent four years in medical school and three years in residency to tell someone not to overdo the big Macs? Tell me another way to waste my time.

I would argue that learning to provide effective healthy lifestyle counseling is a lot more challenging than explaining to patients why antibiotics aren't needed for an uncomplicated URI, or why imaging isn't necessary for acute back pain - something FPs do on a daily basis. Since obesity now rivals tobacco as the most important cause of death in the U.S., we should have received more instruction about nutrition and exercise in medical school and residency, as well as strategies to improve the health of communities. In my opinion, the "time wasted" was all of the other things I was taught instead.

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